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Days after Holli Dunayer-Shalvoy's gastric bypass surgery in 2005, she ventured out onto the beachside boardwalk near her Long Beach, New York, home. Her first walks were short, but each day they got a little bit longer. Now, three years after her surgery and more than 120 pounds lighter, Dunayer-Shalvoy runs four miles every morning.

"You hear the doctors say, 'You have to exercise,'" Dunayer-Shalvoy says. "I think it's not a given that you're going to do that. That is where you separate people and their will to succeed. I wanted it. I was hungry for a different life."

Exercise Is Crucial for Weight-Loss Success

Exercise after gastric bypass surgery is critical for effective weight loss, says Christopher Still, DO, director of the Geisinger Obesity Institute in Danville, Pennsylvania, and a member of the Integrated Health program of the American Society for Metabolic and Bariatric Surgery (ASMBS).

"When we lose weight rapidly, we lose muscle," Dr. Still says. "Muscle gauges and controls our metabolism. Exercise is a safe and effective way of maintaining lean body mass, which maintains metabolism and will facilitate [healthy] weight loss."

A recent study reported in the journal Obesity found that of 190 patients who underwent bariatric surgery, 68 percent said that they became physically active in the year after the procedure — "active" defined as at least 200 minutes per week of walking or other moderate or vigorous exercise. The exercisers lost an average of 13.2 more pounds than inactive patients and also suffered from less depression and anxiety and had higher scores in general health./p>

Exercise also shortens recovery time for bariatric surgery patients and reduces the risk of postsurgical complications. In addition, physical activity improves mood and reduces stress, according to the ASMBS. "People who choose to put an emphasis on exercise lose more weight and have an easier time with weight maintenance," Still says.

Kristine Salmon, an exercise physiologist with the Banner Good Samaritan Bariatric Center in Phoenix, offers the following example of a typical exercise program recommended to bariatric surgery patient:

6–12 Months Before Surgery

Patients who start an exercise regimen before surgery are twice as likely as those who don't to have an easy time adjusting to exercising after surgery, according to a Harris survey conducted for ASMBS. But exercise is almost always difficult for people who carry a lot of extra weight. For this reason, starting slow is imperative. If you are morbidly obese and are contemplating an exercise regimen, you should have a cardiac evaluation by your internist. The goal, says Salmon, should be 20 to 30 minutes of physical activity three days a week. Some sample exercises:

Walking for 10 minutes, twice a day.

Marching in place for 20 minutes while sitting in a chair (especially effective for people with back problems).

1–6 Months After Surgery

You should resume an exercise regimen two to three weeks after bariatric surgery. The goal is to increase range of motion so you can take off your shoes, for example, and pick things up off the ground. Strength-training exercises are also important because as you lose weight you will lose muscle. You should work toward 30 minutes of continuous exercise three to five days per week by the time six months have passed. Sample exercises during this stage:

A year after gastric bypass, you should be able to perform 45 minutes of exercise at least four times a week. Salmon recommends varying workouts so your body is constantly challenged. Strengthening the stomach muscles is also important because it helps improve your posture, which will change as you lose more weight. Some sample exercises:

Yoga, dancing, aerobics, or kickboxing for 45 minutes four times a week.

Resistance training using dumbbells while sitting on a balance ball, which helps to strengthen the abdominal muscles.

1 Year–Plus After Surgery (Long-term Maintenance)

Now that more than a year has passed since surgery, you've probably lost more than 100 pounds. Such a drastic change can leave many patients thinking that they no longer need to exercise, but "we tell patients that exercise is not an option, it's a must," Salmon says. At this stage the recommendation is the same as that for the general population: 45 minutes of exercise at least four days per week. Sample exercises:

Interval training on a treadmill, varying speed and incline, for 45 minutes.

Hiking, running, or bicycling — take your exercise outdoors and be proud of your new body and how good it feels to be physically fit.

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